PURPOSE: An economic evaluation of platelet glycoprotein IIb/IIIa inhibitors as adjuncts in percutaneous coronary intervention (PCI) with stent implantation.

METHODS: The study population was patients with acute coronary syndrome undergoing PCI with stenting. The intervention was glycoprotein IIb/IIIa inhibitors (abxicimab or eptifibatide) plus usual care. The comparator was usual care (PCI with background therapy of ASA and anti-platelet therapy such as unfractionated heparin or clopidogrel). A decision analytic model was constructed with a Canadian provincial health insurance payer perspective (Ontario). Short-term models were constructed based on data from relevant clinical trials. Long-term models were developed using the Markov technique. DATA by Triage software was used for the decision analysis. Probabilistic sensitivity analysis was done using Crystal Ball software.

RESULTS: In the overall population, relative to stenting alone eptifibatide was dominant in the short-term in terms of costs (reduced by $59), rates of major adverse cardiac events (5.6% lower) and mortality (1% lower). (Also for the diabetic population: lower by $166, 7.1% and 2%, respectively). Similarly, in the long-term analysis eptifibatide overall showed lower costs ($59 less) and increased life years (0.22 unadjusted and 0.12 adjusted). For abciximab, costs were higher ($1,171 more) and clinical outcomes were better (MACE reduced by 7% and mortality by 1%) relative to stent alone. An incremental cost-effectiveness analysis found there is an additional cost of $17,000 per life year gained when abciximab is used as an adjunct to stenting with PCI. That falls within the bounds of what is commonly considered cost-effective.

CONCLUSIONS: Platelet activation and aggregation are pivotal in the clinical complications of PCI with stenting. This study suggests eptifibatide and abciximab are cost-effective adjuncts for control of these complications.

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